Company proposes 43-bed psychiatric hospital in Brier Creek

In the midst of a chronic statewide shortage of treatment options for mentally ill residents, a Kentucky company is proposing to build a 43-bed psychiatric hospital in Raleigh.

Local mental health advocates caution that the proposed Triangle Springs psychiatric hospital in Brier Creek is not likely to admit those in most need of the services: the uninsured and Medicaid patients who depend on state facilities for free psychiatric services.

Still, no one is trying to block the project in a region where mentally ill patients can spend several weeks in a hospital emergency room waiting for a bed to free up in a state mental health hospital.

“We have an incredible shortage of psychiatric and behavioral health facilities,” said W. Stan Taylor, WakeMed’s vice president for corporate planning. “With the high demand for this resource in our community, we’re very happy they’re interested in this market.”

In the Triangle’s crowded health care market, expanding health care services typically triggers a legal fight with rival providers, and building a new hospital can be subject to years of challenges and appeals.

Triangle Springs and its parent company, Springstone, selected the Triangle because of the region’s unmet need for mental health care, said Springstone general counsel Jill Force. The company solicited letters of support from WakeMed Health & Hospitals, the local chapter of the National Alliance on Mental Illness, as well as a half-dozen local psychiatric practices.

Triangle Springs said in its public filing that the $15.8 million psychiatric hospital is expected to begin operations Jan. 1, 2018 and would serve Wake, Durham, Johnston and Cumberland counties. The hospital would be built along T.W. Alexander Drive, near the WakeMed Brier Creek Healthplex and a slew of shops and restaurants clustered around Glenwood Avenue and Brier Creek Parkway.

The deadline for challenging the facility came and went last week and the proposal is set to be discussed at a June 18 public hearing in Raleigh. A ruling by the N.C. Department of Health and Human Services is expected in late July, or in late September if the agency extends the review period.

The lack of psychiatric beds is so acute in Wake County that earlier this year WakeMed closed its emergency room to non-serious cases for 3-1/2 hours because its ER overflowed with 65 psychiatric patients.

Rex Hospital in Raleigh was the subject of a federal investigation this year after a mentally ill patient was Tasered and kept in restraints for extended periods of time. The patient was involuntarily committed to Rex for 18 days while he awaited a bed at a state mental hospital.

In its application, Triangle Springs presents itself as an enlightened, humane provider of services to society’s most vulnerable population. For example, the company said it has a policy of not restraining or drugging mentally ill patients unless there is no other way to keep them safe.

“Although unusual for the industry, Springstone hospitals do not use either mechanical (e.g straps, bed side rails) or chemical (e.g. drugs or medication) restraints,” the company said, “and any restraints or seclusion techniques are temporary and short-lived.”

In North Carolina, hospitals and other health care providers are required to apply for a “certificate of need” to expand services or facilities. The rationale for the regulatory review process, which is used in more than two dozen states, is to prevent a health care arms race that would lead to overbuilding and driving up prices for consumers.

Still, two competing mental health hospitals, 80-bed Holly Hill Hospital and 16-bed UNC Hospitals at WakeBrook, didn’t file comments. UNC’s WakeBrook is in the midst of an expansion that will add 12 beds to the facility this year.

According to Springstone’s analysis, the Triangle needs 131 more psychiatric beds, so a 43-bed hospital will not oversaturate the market.

Another health care group, Alliance Behavioral Healthcare, which administers North Carolina’s Medicaid services, didn’t write a letter of support for the Triangle Springs hospital because the psychiatric facility will cater to people with private insurance, said ABH spokesman Doug Fuller.

“Our customers would not be served by that facility,” Fuller said. “Our customers don’t have private insurance.”

Under federal law, a stand-alone psychiatric facility with more than 16 beds can’t be reimbursed for treating Medicaid patients. As a result, Medicaid-eligible patients aged 22 to 64 generally have limited coverage for psychiatric care.

Gerry Akland, president of the Wake County branch of the National Alliance on Mental Illness, said he doubted Triangle Springs would be able to serve many of these non-paying patients.

“It seems to me it’s hard to make a profit doing too much of the good stuff,” Akland said. “That’s the reality we’ve been living with.”

Triangle Springs vows to treat more non-paying patients than a typical private psychiatric hospital, even if it doesn’t have a contract to be paid for those services.

“This is our approach in other states,” Force said. “As a new provider, we cannot assume that we will have such contract. In the absence of such a contract, we will treat non-paying uninsured and Medicaid patients at a higher rate.”

The company’s application states: “Triangle Springs believes that its willingness to care for these patients, without regard for their ability to pay is an important feature of its proposed project.”

Springstone operates eight psychiatric hospitals in Ohio, Indiana and Texas, and is in the process of building three more in Arizona, Kansas and Ohio. The company told regulators in its filing that it has never been fined or had its license revoked.